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Provider Enrollment Form
OMB 1215-0137
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DOL/ESA
OMB 1215-0137
OMB 1215-0137
Latest Forms, Documents, and Supporting Material
Document
Name
Form OWCP-1168 Provider Enrollment Form
Form
SS 1215-0137 SS 9-24-2009 final[1][1].doc
Supporting Statement A
Provider Enrollment Form
Form
All Historical Document Collections
200906-1215-001
Approved without change
Extension without change of a currently approved collection
2009-10-06
200610-1215-005
Approved without change
Extension without change of a currently approved collection
2006-11-08
200506-1215-005
Approved without change
No material or nonsubstantive change to a currently approved collection
2005-06-29
200312-1215-004
Approved without change
Extension without change of a currently approved collection
2003-12-17
200301-1215-005
Approved without change
Revision of a currently approved collection
2003-01-16
200112-1215-004
Approved without change
Revision of a currently approved collection
2001-12-19
200107-1215-005
Approved without change
No material or nonsubstantive change to a currently approved collection
2001-07-06
199812-1215-002
Approved without change
Extension without change of a currently approved collection
1998-12-01
199512-1215-002
Approved without change
Extension without change of a currently approved collection
1995-12-07
199212-1215-001
Approved without change
Revision of a currently approved collection
1992-12-28
198912-1215-002
Approved without change
Revision of a currently approved collection
1989-12-18
198704-1215-003
Approved without change
Reinstatement with change of a previously approved collection
1987-04-09
198404-1215-001
Approved without change
Revision of a currently approved collection
1984-04-05
198309-1215-039
Approved with change
No material or nonsubstantive change to a currently approved collection
1983-09-06
198205-1215-002
Approved without change
New collection (Request for a new OMB Control Number)
1982-05-28
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